超声造影对急性肾损伤治疗后肾血流灌注水平的评价  

Evaluation of renal perfusion level after continuous renal replacement therapy for septic acute renal injury by contrast-enhanced ultrasound

作　　者：陈杰桓 许志荣 刘颖培 杨帅 周芙蓉 陈斌 谭雷[4] Chen Jiehuan;Xu Zhirong;Liu Yingpei;Yang Shuai;Zhou Furong;Chen Bin;Tan Lei(Department of Ultrasound,the Binhaiwan Central Hospital,Dongguan 523000,China;Department of Critical Care Medicine,the Binhaiwan Central Hospital,Dongguan 523000,China;Mindray Bio-Medical Electronics CoL,td,Shenzhen 518057,China;Department of Ultrasound,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]东莞市滨海湾中心医院超声科,523000 [2]东莞市滨海湾中心医院重症医学科,523000 [3]迈瑞生物医疗电子股份有限公司,深圳518057 [4]中山大学附属第三医院超声科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第1期58-62,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：东莞市社会科技发展项目(202050715025595);东莞市滨海湾中心医院院内科科研项目(2021001)。

摘　　要：目的本研究旨在通过超声造影(CEUS)评估脓毒症性急性肾损伤(SAKI)患者连续性肾脏替代治疗(CRRT)前后肾脏微循环灌注量,探讨其在SAKI患者CRRT后肾脏血流灌注水平的诊断价值。方法选择2020年3月至2021年3月东莞市滨海湾中心医院重症医学科脓毒症患者77例作为研究对象。研究分为非AKI和SAKI两组,其中非AKI患者35例和SAKI患者42例,而SAKI组中分为CRRT与未行CRRT两组,而根据CRRT后肾功能恢复情况再分肾功能好转组和未好转组。所有研究对象均通过超声造影动态分析获取肾脏造影参数:峰值强度(PI)、达峰时间(TTP)、曲线下面积(AUC)。结果SAKI组与非AKI组对比PI减弱、TTP延长、AUC减少(P均<0.05),SKAI组CRRT后对比CRRT前PI增强、TTP缩短、AUC增加(P均<0.05),SKAI组CRRT后肾功能好转组和未好转组比较,PI增强、TTP缩短、AUC增加(P均<0.05)。SAKI组中经CRRT后肾功能好转组和非AKI组比较,PI、TTP、AUC差异均无统计学意义(P>0.05)。结论肾脏超声造影定量分析可在一定程度反映SAKI患者CRRT前后肾功能的变化,有望作为床旁评价SAKI患者CRRT后肾血流灌注水平的一种有效手段。Objective To evaluate renal microcirculation perfusion before and after continuous renal replacement therapy(CRRT)in patients with septic acute renal injury(SAKI)by contrast ultrasonography(CEUS),and to explore the diagnostic value of CEUS in renal blood perfusion level after CRRT treatment in SAKI patients.Methods Seventy-seven patients with sepsis in the Intensive Care Department of Binhaiwan Central Hospital of Dongguan from March 2020 to March 2021 were selected as subjects.The patients were divided into two groups,non-AKI group(35 cases)and SAKI group(42 cases),while the SAKI group was divided into CRRT group and no CRRT group.And renal function recovery after CRRT was divided into two groups:functional improvement group and non-improved group.All subjects obtained renal angiography parameters by dynamic analysis of contrast-enhanced ultrasound:peak intensity(PI),time to peak(TTP),and area under the curve(AUC).Results Compared with non-AKI group,SAKI group decreased PI,prolonged TTP,and decreased AUC(all P<0.05),in the SKAI group,PI was enhanced,TTP was shortened,and AUC was increased after CRRT compared with that before CRRT(all P<0.05).In the SKAI group,compared with the non-improved group,PI enhanced,TTP shortened and AUC increased in the functional improvement group(all P<0.05).There was no significant difference in PI,TTP and AUC between the functional improvement group of SAKI patients after CRRT and the non AKI group.Conclusions The quantitative analysis of renal contrast-enhanced ultrasound can reflect the changes of renal function before and after CRRT treatment in SAKI patients to a certain extent,which is expected to be an effective means for evaluation of renal blood perfusion level after CRRT in SAKI patients.

关 键 词：超声造影 脓毒症 急性肾损伤 连续性肾脏替代治疗 

分 类 号：R699.2[医药卫生—泌尿科学]